eclinicalworks clinician training guide€¦ · 19-11-2018 · located in the right chart panel...

Last Updated on 11/19/18 by Sarah Labriny of 40

eClinicalWorks Clinician Training Guide

Outline

I. Login II. Office Visit Screen III. Prepping for a Patient

a. Patient Dashboard i. Viewing Past Appointments

ii. Looking at Test Results b. Right Chart Panel (medical summary and patient histories)

IV. Charting Workflow for Typical Appointment a. Overview of Progress Note Navigation b. Clinician HPI c. Review and Revise sections (Histories, Current Rx…etc.) d. Examination e. Assessment f. Treatment

i. Medication ii. Labs

iii. Diagnostic Imaging iv. Referrals

g. Immunizations h. Check-Out Sheet i. Next Appointment j. Locking Progress Note

V. Looking Up a Patient

Part I. Login

Logging into Volunteer Computer (autoECW User)

Windows Password: autoECW!@#

Logging into eClinicalWorks (eCW)

Look for the eCW icon and double click to open the application

Login with personal volunteer credentials

Change Password: Go to File>Change Password

My eCW username: ___________________________________

My eCW Password: ____________________________________

**Please contact Sarah Labriny if you have questions or concerns regarding eClinicalWorks at CrossOver Healthcare

Ministry:

Sarah Labriny, EHR Coordinator

[email protected] , 804-422-2600 x.124

mailto:[email protected]


Part II. Office Visit Screen (Clinician Schedule)

When clinicians login to eClinicalWorks, it will open to the Office Visit Screen, which displays the clinician’s appointment schedule for the day:

Visit types [#3] New Patients (NP), Physical (PHYS), Established Patient (ESTPT)

Reason [#4] A general reason for the appointment that loads the template into the progress notes (e.g. PHYSICAL, PRIMARY CARE, WELL WOMAN EXAM).

Visit status [#5]

= Patient has arrived.

= Patient checked out at front desk.

= Patient has not checked in for appointment yet.

Status [#6]

Order of statuses: NUR, Ready for, SV (clinician), Done (clinician)

Ready = patient is ready to be seen by clinician

Change Status to SV (Start Visit)

[#7]

Indicates that

the nurse has

taken vitals.

**NOTE: Clinicians can also access this Office Visit Screen by clicking on the “S” Jellybean located on the top right of the screen (the jellybean is the circle to the right of the S). This will be helpful when navigating back and forth between appointments:

[#8] Double Click on the patient’s name

to enter the patient’s chart.

[#1] Select the “P” radio button on the top left.

[#2] Select your name from the drop down list of clinicians. Make sure that the Facility and Appt. time are set appropriately or nothing will appear in your schedule.


Part III. Prepping for a Patient

Section A. Patient Dashboard

Encounters: View past progress

notes.

See pg. 4

Patient Language: Identify if patient needs a translator.

If a translator is needed, please ask

front office for an interpreter or use

the language line (number found at

Nurses Station).

Patient Docs: contains scans of hospitalization records, discharge papers, external test results…etc. See pg. 6

DI: View DI

orders and

results.

See pg. 6

Labs: View Lab

orders and

results.

See pg. 5


Viewing Past Appointments

Click on “Encounters” in the Patient Dashboard (or the Encounters button in the Patient Hub).

View the Progress Notes from past appointments by double clicking into the row of the

appointment.

View the locked progress note:


Finding Test Results Test results are generally in one of three places:

1. Labs 2. DI 3. Patient Documents

You can access these sections through the Patient Dashboard in the Progress Note or through the Patient Hub (see Part V. of this guide).

1—Labs

View In-House Lab results by double clicking on the lab order and viewing the yellow row in the center of the screen.

In Labs, a paperclip indicates that a result is present. Click on the paperclip to open up the results window.

Received: Indicates

whether we have received

the lab result.

Reviewed: Indicates

whether the result

has been reviewed

by a staff clinician.

Find In-House Lab results

recorded in the yellow

line (that is the line that

corresponds to that

order).


2—DI (Diagnostic Imaging)

The DI window functions the same as the Labs window. View results by clicking on

the paperclips.

However, oftentimes, DI results are scanned into our system and can be found in

Patient Documents.

3—Patient Docs

Patient Docs contains any documents pertaining to the patient that have been

scanned into eCW (Hospitalization records, Discharge papers, Cardiology test

results…etc.). Check Patient Docs if you cannot find a test result in Labs or DI.

If there is a document

in the folder, it will

appear as a branch of

that folder. Click on the

document and it will

appear in the viewer to

the right.

Use the scroll

bar to view

the rest of

the results.

Use arrows

to navigate

through

pages.


Section B. Right Chart Panel

Right Chart Panel: Overview Tab Located in the Right Chart Panel (on the right side of the patient progress notes) is the Overview tab,

which includes the patient’s problem list, current medications, allergies, immunizations, and therapeutic

injections. This tab is a useful and efficient way to view patient information without leaving the progress

notes.

Click on “Overview in the

Right Chart Panel

Click on Blue arrows

to move problem list

diagnosis over into

today’s progress

notes.

Scroll down to

view Current

Medication,

Allergies,

Immunizations,

and Therapeutic

Injections sections.

Click on plus sign to

display more details

about the immunization.

A minus sign will appear

with bullet points

detailing the date of the

vaccine and which dose

it was in the series.

The Problem List

contains the patient’s

chronic conditions

that have already

been diagnosed.


Right Chart Panel: DRTLA Tab Located in the Right Chart Panel (on the right side of the patient progress notes) is the DRTLA tab, which

stands for Documents, Referrals, Telephone Encounters, Labs, and Actions. This tab is a useful and

efficient way to view both orders and results of patient labs, diagnostic images, and referrals without

leaving the progress notes.

Use the drop-down menu to select how far back

you would like to view labs, diagnostic images,

referrals…etc.

Pink paper clips mean that an electronic result

has been received. Click on the pink paper clip to

view lab results. (Same for Diagnostic Images)

Date of lab order

Click on “DRTLA” in the Right Chart Panel

Click on the reason for the referral to view the

“Outgoing Referral Window”, where you will see

a “specialty” field indicating what kind of

specialist the patient has been referred to.

Date referral was made in eClinicalWorks

Scroll down to view Referrals section.


Right Chart Panel: History Tab Located in the Right Chart Panel (on the right side of the patient progress notes) is the History tab, which

includes the Review medical, gynecological, surgical, family, and social histories. This tab is a useful and

efficient way to view patient information without leaving the progress notes.

Click on “History” in the

Right Chart Panel

Scroll down to

view Social History.

(Gyn History will

appear as a

separate section

for female

patients.)


Part IV. Charting Workflow for a Typical Appointment

1. Chief Complaint

2. HPI: Nurse Interview

2. HPI: -Clinician HPI [if new patient then also fill out:

-PHQ-2 -Sexual History]

3. Current Medication

4. Medical History

5. Allergies

6. *GYN History

7. *Surgical History

8. *Hospitalization History

9. *Family History

10. *Social History (2 folders) :

Social History, General TOB/OB/Drugs

11. Vitals

12. Examination

13. Assessment

14. (Treatment: Nurses place standing orders only)

14. Treatment

15. Immunizations: Administer immunizations

(Nurses only place the standing order immunization: flu shot.)

15. Immunizations: Order Immunizations

16. Next Appointment

* = only necessary to fill out for New Patient appointment

Review & Revise

these sections


Section A: Overview of Progress Note Navigation

Definition: Progress Notes are the equivalent of a patient’s paper chart for that appointment.

1. To enter the Progress Notes for a particular patient, double click on the patient’s name from the Office Visit Screen (S Jellybean).

2. To open a section of the Progress Note, click on the corresponding blue hyperlink. The first

Progress Note section that clinicians fill out (according to the “What Do I Fill Out?” chart above)

is in HPI.

3.


Section B: HPI (History of Present Illness)

1. Click on the “Notes” box that corresponds to Complaint 1.

2. This will open up a dialogue box in which you can free-text the “Subjective” of the SOAP note

* If no mini-template appears on

the progress note, navigate to

Clinician HPI on the left side of

the screen and fill in those

questions

Free-text notes here


3. If the HPI question contains structured data, a new window with questions will appear. Click into the value field until a drop-down menu appears. Make your selection from the drop-down menu. Click into the Notes field to free-text additional notes about that question

Section C: Review and Revise Sections

While the nurse completes the following sections, the clinician is responsible for

reviewing and revising them as necessary:

Current Medication

Medical History and Allergies

GYN History

Surgical History & Hospitalization

Family History

Social History

Vitals

Click on the blue hyperlinks on the Progress Notes to access these sections.


Once you open a hyperlink, you can access other sections of the Progress Note by

clicking on the picture icons located at the top of the hyperlinked screens. Hover

over the picture icons to see which sections they represent:

1—Current Medication (Review and Revise as needed)

This section contains all medication the patient is supposed to be taking according

to what was prescribed during their last visit. The nurse conducts medication

reconciliation prior to the clinician interview with the patient.

Medical History & Allergies

Current Medication

Vitals

Family History

Social History

Surgical History & Hospitalization


Note: medication adherence questions are answered in the Nurse Interview in the

“Adherence” area.


2—Medical History & Allergies (Review and Revise as needed)

Add Medical History and Allergies as needed.

3—GYN History (Review and Revise as needed)

Use the blue hyperlink to access this section.

To add an allergy, click the “Add” button. Then, free-text allergies into Agent/Substance field, and fill

in the type of reaction, type of allergy, and always mark the allergy as Active

Check off NKDA if no known drug allergies.


4—Surgical History & Hospitalization History

Add Surgical and Hospitalization History as needed. Use the “Add” button to add a

new field.

5—Family History (Review and Revise as needed)


6—Social History (Review and Revise as needed)



7—Vitals (Review and Revise as needed)



Section D: Examination

1. Click the green arrows to populate the default setting for a “normal” observation into the

Observation field or click directly into the Observation field to free-text notes.


Section E: Assessments

Every part of the treatment plan in eClinicalWorks must be associated with a diagnosis code. The

purpose of the Assessments screen is to pull up diagnosis ICD-10 codes so that treatment can be

attached to the diagnoses. Use this screen to

1. Pull-up existing diagnoses

2. Put in new Diagnosis codes

1—Pulling-Up Existing Diagnoses

#1 Click on “Previous Assessments” radio button.

*Note: To select an Assessment/Dx code from the

(chronic) Problem List, click the Problem List button.

#2 Select the diagnosis (single click).

The Diagnosis will move into the

“Selected Assessments” section

outlined below.


2—Putting-In New Diagnoses

(Optional): Manage the patient’s Problem List by clicking the Problem List button. Problems

can be added or removed and added to Medical Hx from the Problem List window. If you see

an ICD-9 code on a patient’s problem list, YOU MUST UPDATE IT TO AN ICD-10 CODE! Add the

ICD-10 code and then delete the ICD-9 code.

Click X to save and exit back to the Progress Note.

#1 To search for a new assessment, ensure that you are assigning ICD-10

codes by checking the Use ICD10 box and type into the box on the left by

wording of the assessment or by the code itself. Hit Enter on your keyboard.

(DO NOT check the Real Time box.)

#2 Select the diagnosis (single click).

The Diagnosis will move into the

“Selected Assessments” box outlined

below.

*Note: Clicking on blue diagnoses will

open up a new window of questions

about the diagnosis in order to narrow it

down to the most specific ICD- 10 code.

(Optional): Remove an assessment

selected at this encounter by first

clicking on the diagnosis in “Selected

Assessments” and then the Remove

button

Problem List: Check off the box next to

the ICD-10 code to add it to the

Problem List (chronic conditions).

NOTE: the box does NOT need to be

checked off in order for the diagnosis to

appear in today’s notes.


Section F: Treatment

The Treatment screen is the main ordering hub for clinicians. From this screen, clinicians take treatment

notes, order medication, labs, DI, and referrals. They also make notes about their treatment plan for the

patient.

eClinicalWorks ties every order and note to a diagnosis (assessment). Therefore, it is important that you

pay attention to the Assessment tabs.

1—Medication

See separate handout “ Ordering Medication and e-Prescribing”.

1—Medication [see separate guide on “Ordering and ePrescribing Medication in

eCW”]

TYPE TREATMENT NOTES HERE

Record treatment plan notes in the

“Clinical Notes” section. Make sure

you are on the correct Assessment

tab before you start taking notes.


2—Ordering Labs (from the Treatment Screen)

Lab Ordering Policy:

ALL labs should be ordered as FUTURE ORDERS (even if the hope is that they can be done same day).

The exception to this is that In-house orders that are being performed the same day should be put in

as same day.

1. Click the “Browse” button next to Labs.

2. Select Future Orders


3. ***IMPORTANT: Check off the box next to the Assessment/Dx code for which you are

ordering.

4. Change the search criteria from “Starts with” to “Contains” (this makes the lab easier to find).


5. Type the name of the lab into the “Lookup” field. Select the lab by clicking on it. Select the In-

House option if one exists, otherwise:

If you are at the Henrico Clinic: choose the “Quioccasin” option.

If you are at the Cowardin Clinic: choose the “Cowardin” option.

If both an In-House and location option exist, choose the In-House option.

This will add the lab under “Future

Orders”.


6. The ICD-CPT Association box will appear. Check off the box next to the ICD-10 code for which you are placing the order. (If applicable, check off more than one.) Then, press Ok.

NOTE: You will only get this pop-up window when you place an In-House order.

7. Next, click on the date in the order date column and then use the calendar to select when you would

like the patient to come back in for their lab.

Check off the checkboxes next

to the lab order to indicate:

“S”—for Stat; “F”—for fasting.


8. Click “Ok” at the bottom to return to the Treatment screen.


3—Ordering Diagnostic Imaging

1. Click the “Browse” button next to Diagnostic Imaging.

2. ***IMPORTANT: Check off the box next to the Assessment/Dx code for

which you are ordering.


3. Change the search criteria from “Starts with” to “Contains” (this makes the

order easier to find).

4. Type the name of the DI into the “Lookup” field. All DI orders start with one

of the following: “Ultrasound”, “CT”, “MRI”, “X ray”. Select the DI by

clicking it:

If you are at the Henrico Clinic: choose the “Bon Secours” option.

If you are at the Cowardin Clinic: choose the “HCA” option.

(The only In-House DI is Bladder Scan.)

This will add the DI under “Today’s

Orders”.


5. Check off the box next to the ICD-10 code for which you are placing the order. (If applicable, check off more than one.) Then, press Ok.

NOTE: The “ICD – CPT Association” window below will pop up every time an order is placed that has a CPT code associated with it. Only In-House orders (labs, DI, procedures, and possibly immunizations/therapeutic injections) will have a CPT code associated with them. This means that you will only get this pop-up window when you place an In-House order.

6. Click “Ok” at the bottom to return to the Treatment screen.


4—Making Referrals

1. Fill out the back of the Check-Out Sheet as follows:

If the referral is a Routine Check-Up for Ophthalmology, Dental, or Well Woman exam: DO NOT enter referral in eClinicalWorks. Simply mark next to the corresponding Routine Check-Up on the Check-Out sheet.

Otherwise: It must be entered in eClinicalWorks (as seen below) AND marked on the check-out sheet. Use the “CrossOver In-House and Outside Referral Availability” document to determine whether the referral is CrossOver (In-House) or Access Now. This document will automatically load as the last tab in Internet Explorer.

8.

2. From within the Treatment window, click Assessment/Diagnosis tab for which you are writing a referral. 3. Then click the “Outgoing Referral” button. (Note: Although the button is called “Outgoing Referral”, it is used to make both In-House CrossOver referrals and Access Now referrals.)

2.

3.


(*Fill out the Outgoing Referral form according to the red asterisks) 4. Select the Specialty to which you are referring. 5. Select either “Referrals, Cowardin” or “Referrals, Henrico” in the Assigned To field according to the clinic at which you are serving. 6. Select the Priority of the referral in the corresponding field. 7. Under the Diagnosis/Reason tab, click the Add button and free-type the reason for referral and any special instructions. If your explanation is too long for the first dialog box, use the add button (7) to add more dialog boxes and finish your explanation in the next box(es). Otherwise, your description will get cut-off and the next provider will not be able to read your reason for the referral. 8. Click Structured Data button.

4.

5.

6.

7.

8.

9. Double click in the Value column next to “Referral System” and a drop-down menu will appear. Select either “In House Specialty at CrossOver” OR “Access Now”. (Do not select bottom three options unless instructed to do so.) 10. Click the OK button. DO NOT CLICK SEND REFERRAL!

9.

10.


Section G: Immunizations/Therapeutic Injections

Ordering an Immunization is 2-step Process:

Step 1—Check Immunization Hx to make sure that the patient has not already received the immunization.

Step 2—Ordering Immunization

1—Checking immunization History

Click “Immunization” on the Patient Dashboard to view the patient’s Immunization History.

**DO NOT ORDER IMMUNIZATIONS FROM THIS SCREEN.**

2—Ordering Immunizations and Therapeutic Injections

1. After you have checked the patient’s Immunization/Th. Inj. History, Click the Immunizations or Therapeutic Injections

link on the Progress Note under “Plan”:

2. Click Add next to Immunizations or Therapeutic Injections to add an order


3. Search for the order on the left side of the screen and select it

4. Select whether or not vaccination has been given in the past.

5. Associate it with an Assessment.

6. Press Ok. (The person who administers it will fill in the rest.)

Section H: Check-Out Sheet

Indicate when

you would like

the patient to

return for a

follow-up.

Nurse visit: short

10-15 min visit

with the nursing

team for BP

check, INR, DEPO,

etc.

Lab visit: short

10-15 min visit

with the nursing

team to drawn

lab.

*Indicate whether

or not it is a

fasting lab.


Section I: Next Appointment

Enter the follow-up time frame in the Follow Up field or check the “Follow N/A” box if no follow up is needed.

IMPORTANT: Scribes and Medical Students must enter the appropriate signature in the Follow Up field:

Scribe signature: <Time Frame>, <Progress Note documented by scribe <First Name, Last Name>>

Example: 2 weeks, Progress Note documented by scribe Sarah Labriny

Medical Student signature: <Time Frame>, <Seen and Examined by First Name, Last Name>

Example: 2 weeks, Seen and Examined by Sarah Labriny

Residents: See How to Co-Sign and Lock Progress Notes guide to for finalizing Progress Notes

Click Close


Section J: Locking the Progress Note

Click the caret next to Lock. Then select “Modern I Style”. This will lock the note, closing editing capabilities.

Documentation completed?

Return to the schedule by clicking S jellybean

Change Floor Status by clicking into Status field and selecting “ALL DONE”

End of Shift

The Provider must lock their progress notes!

You may do this either at the end of your shift for all appointments (recommended) or as you finish

with each patient

1. At the bottom of the Progress Note, select the arrow next to the Lock button

2. Select “Lock Modern I Style”

3. Upon prompt, click Yes to lock encounter

4. Return to S jellybean and repeat for each progress note


Part V. Looking up a Patient

1. Lookup Patient using “Sherlock”

Allows user to search for a patient by “last name, first name” or by DOB

2. This will take you to the Patient Hub. In the Patient Hub, users can acces the same medical information they

would find in the progress note including labs, DI, referrals, Patient Docs, Immunizations, Allergies and other

sections described in the above guide in pages 3-6. (This is a secondary way to access those sections.)

Clicking here will

take you to the

Patient Hub


Logout of eCW

To logout of eClinicalWorks, click the X in the top right corner of the eClinicalWorks window. When prompted, click Yes

to close the application.

When you are finished with your shift, please close all

applications and SHUT DOWN your computer!

Thank you


Computer Usage Guidelines

1. Sign computers in and out.

2. Do NOT remove the chargers from the charging

stations.

If the computer is low on battery, use an extra charger located

on the bottom of the computer rack.

3. Do not leave your computer unattended with eClinicalWorks open. Log out

of eClinicalWorks if you walk away from your computer.

4. Position computer so that patients cannot see your screen. It is a HIPAA

violation for patients to be able to see the eClinicalWorks application.

5. After shift:

Close all applications and SHUT DOWN computer. (see how to guide

on shutting down comp.)

PLUG COMPUTER INTO ITS ASSIGNED CHARGING STATION.

(ex: PM2 PM2)